Intermediate Acting Steroid

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  • Corticosteroid Dose Equivalents
  • CE: Oral Corticosteroids
  • Corticosteroids
  • Corticosteroids and Corticosteroid Replacement Therapy | Patient
  • Corticosteroid - Wikipedia
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    Corticosteroid Dose Equivalents

    intermediate acting steroid Chandler Medical Center, Lexington, Kentucky. Systemic corticosteroids have been used in the treatment of numerous medical conditions for approximately 50 intermediate acting steroid. Short-acting products such as hydrocortisone are the least potent. Prednisone and methylprednisolone, which are intermediate-acting products, are four to five times more potent than testerone 250. Dexamethasone is a long-acting, systemic corticosteroid; its potency is about 25 times greater than the short-acting products.

    CE: Oral Corticosteroids

    intermediate acting steroid

    The corticosteroids are a group of chemically related natural hormones and synthetic agents that resemble the human adrenal hormone cortisol and have potent antiinflammatory and immunosuppressive properties and are widely used in medicine. Corticosteroid therapy is associated with several forms of liver injury, some due to exacerbation of an underlying liver disease and some that appear to be caused directly by corticosteroid therapy. This discussion will cover eight agents: Cortisol and the corticosteroids act by engagement of the intracellular glucocorticoid receptor, which then is translocated to the cell nucleus where the receptor-ligand complex binds to specific glucocorticoid-response elements on DNA, thus activating genes that mediate glucocorticoid responses.

    The number of genes modulated by corticosteroids are many and the effects are multiple and interactive with other intracellular pathways. Thus, the effects of corticosteroids on inflammation and the immune system cannot be attributed to a single gene or pathway. The potent antiinflammatory and immunosuppressive qualities of the corticosteroids have made them important agents in the therapy of many diseases. Corticosteroids are available in multiple forms, including oral tablets and capsules; powders and solutions for parenteral administration; topical creams and lotions for skin disease; eye, ear and nose liquid drops for local application; aerosol solutions for inhalation and liquids or foams for rectal application.

    Representative corticosteroids and the year of their approval for use in the United States include cortisone , prednisone , prednisolone , methylprednisolone , dexamethasone , betamethasone , and hydrocortisone All are available in generic forms. In this website, only the oral and intravenous formulations of corticosteroids are described and they are discussed together with common list of references and representative case reports.

    The corticosteroids are used widely in medicine largely for their potent antiinflammatory and immunosuppressive activities. The clinical conditions for which corticosteroids are used include, but are not limited to: Corticosteroids are used in several liver diseases, most commonly in autoimmune hepatitis for which they have been shown to improve outcome and survival.

    Corticosteroids are also used after liver transplantation to prevent rejection. An important element in managing these liver diseases and conditions is to maintain the dose of corticosteroids at the lowest effective level. The adverse effects of long term corticosteroid therapy which are rarely hepatic are still major causes of morbidity and even mortality in these conditions. Prednisone, prednisolone, methylprednisone and triamcinolone are the most commonly used oral agents as they are inexpensive, rapid in onset, intermediate in duration of action and have potent glucocorticoid with minimal mineralocorticoid activities, at least as compared to cortisone and hydrocortisone.

    Betamethasone and dexamethasone have greater glucocorticoid potency and less aldosterone-like activity than prednisone, but have a longer duration of action, and they are mostly used in topical or liquid forms for local application and in injectable forms for severe hypersensitivity reactions and inflammation. Methylprednisone and hydrocortisone are most commonly used for intravenous administration, typically given in emergency or critical situations in which rapid and profound immunosuppression or antiinflammatory activity is needed.

    The table below provides the major forms of corticosteroids and their relative glucocorticoid and mineralocorticoid activity and equivalent daily doses. Cortisone is available in generic forms in tablets of 25 mg, which is considered a daily physiologic dose in adults. Cortisone has both glucocorticoid and mineralocorticoid properties.

    Hydrocortisone hye" droe kor' ti sone is a rapid and short acting glucocorticoid that is used for therapy of adrenal insufficiency and in treatment of allergic and inflammatory conditions. Hydrocortisone has the same chemical structure as cortisol and thus most closely resembles the human adrenal hormone.

    Hydrocortisone is available in generic forms in tablets of 5, 10 and 20 mg, with 20 mg being considered a daily physiologic dose in adults. Hydrocortisone is also available in multiple forms in solution for oral, rectal, topical or parenteral administration. A major use of intravenous hydrocortisone is in the acute therapy of severe hypersensitivity reactions and shock. Hydrocortisone has both glucocorticoid and mineralocorticoid properties.

    Prednisone pred' ni sone is a synthetic, intermediate acting glucocorticoid that is widely used in the therapy of severe inflammation, autoimmune conditions, hypersensitivity reactions and organ rejection.

    Prednisone is converted to prednisolone, its active form, in the liver. Prednisone is available in multiple generic forms in tablets of 1, 2. Four times more potent that cortisol, prednisone is used in varying doses, with 5 mg daily being considered physiologic doses in adults. Prednisolone is available in multiple generic forms in tablets of 5, 10, 15 and 30 mg and in several forms for systemic administration. Four times more potent that cortisol, prednisolone is used in varying doses, with 5 mg daily being considered physiologic doses in adults.

    Methylprednisolone meth" il pred nis' oh lone is a synthetic, intermediate acting glucocorticoid that widely used in the therapy of severe inflammation, autoimmune conditions, hypersensitivity reactions and organ rejection.

    Methylprednisolone is available in multiple forms in tablets of 2, 4, 8, 16 and 32 mg generically and under the brand name of Medrol and in Medrol Dosepaks 21 tablets of 4 mg each. Injectable forms of methylprednisolone are also available generically and under brand names of Solu-Medrol and Depo-Medrol.

    Five times more potent that cortisol, methylprednisolone is used in varying doses, with 4 mg daily being considered physiologic doses in adults. Methylprednisolone has minimal mineralocorticoid activity. Triamcinolone trye" am sin' oh lone is a synthetic, long acting glucocorticoid that is used in topical solutions and aerosols for therapy of allergic and hypersensitivity reactions and control of inflammation as well as in parenteral formulations for therapy of hypersensitivity reactions, shock and severe inflammation.

    Oral forms of triamcinolone include tablets of 4 and 8 mg and oral syrups. Parenteral forms for injection are available under various generic and trade names including Aristocort and Kenacort.

    Triamcinolone is five times more potent than cortisol in its glucocorticoid activity, but has minimal mineralocorticoid activity.

    Dexamethasone dex" a meth' a sone is a synthetic, long acting glucocorticoid that is used parenterally as therapy of severe hypersensitivity reactions, shock and control of severe inflammation as well as in topical, otic, ophthalmologic solutions, aerosols and lotions or creams for local therapy of allergic reactions and inflammation. Dexamethasone is available in multiple forms for injection under various generic and trade names including Decadron.

    Dexamethasone is 25 times more potent than cortisol in its glucocorticoid activity, but has minimal mineralocorticoid activity. Betamethasone bay" ta meth' a sone is a synthetic, long acting glucocorticoid that used in parenteral forms for therapy of allergic and hypersensitivity reactions and control of severe inflammation.

    Betamethasone is available in solution for injection under the trade name of Celestone and in multiple generic forms as syrups and effervescent tablets for oral use, edemas and foams for rectal use, aerosols for nasal and respiratory use, and creams and lotions for topical use.

    Betamethasone is 25 times more potent than cortisol in glucocorticoid activity, but has minimal mineralocorticoid activity. Selected Drugs in the Class: A 34 year old woman with systemic lupus erythematosis was treated with betamethasone with good clinical response with improvements in rash, fatigue and laboratory tests.

    Over a 6 month period, the daily dosage was gradually decreased from 5 to 1. Her weight had risen by 11 kilograms and she had firm hepatomegaly. Laboratory tests showed elevations in serum aminotransferase levels, but normal serum bilirubin, albumin, and prothrombin time. Testing for HBsAg was negative. She was known to be positive for antinuclear antibody 1: She denied alcohol use, which was confirmed by family and friends. A liver biopsy showed marked steatosis with inflammation including neutrophils, occasional Mallory bodies and mild central sinusoidal and portal fibrosis.

    Weight loss led to slight decreases in serum ALT levels. This is an early, but well documented report of nonalcoholic steatohepatitis arising during corticosteroid therapy. The patient was evidently asymptomatic of liver disease, but the height of the serum aminotransferase elevations led to a hospital admission and liver biopsy.

    An issue is whether the liver disease was due to corticosteroid therapy directly or was the result of weight gain and insulin resistance caused by the therapy.

    Betamethasone is a synthetic, high potency glucocorticoid; 1. A 69 year old man with ulcerative colitis and the HBsAg carrier state developed jaundice and hepatitis after 9 months of continuous prednisolone therapy and shortly after intravenous pulse treatment with methylprednisolone.

    Because of relapsing ulcerative colitis, he was started on prednisolone therapy in tapering doses 60 mg daily down to 5 mg daily. Approximately 8 months into therapy, he received a 7 day course of intravenous methylprednisolone. One week later, while still on low doses of oral prednisolone, he developed fatigue and nausea.

    On examination, he was jaundiced and had mild mental dullness and asterixis. In addition he had IgM anti-HBc. Despite initiation of lamivudine therapy for hepatitis B and intensive medical management, he developed progressive liver failure, coagulopathy, hepatic coma and died 25 days after admission.

    Reactivation of hepatitis B in an HBsAg carrier can be followed by a severe episode of hepatitis as immunosuppression is withdrawn. Many cases present as "acute-on-chronic" liver failure rather than classical acute liver failure.

    The prognosis is poor and antiviral therapy appears to have little effect once hepatic failure is present. HBsAg carriers who undergo immunosuppressive therapy with prednisone should be monitored and prophylaxis during the immunosuppression with an oral nucleoside analogue such as tenofovir or entecavir is appropriate. A 43 year old woman with Graves disease developed worsening ophthalmopathy despite adequate control of thyroid function. Over the next six weeks, serum aminotransferase levels rose further Table , with no or minor elevations in serum alkaline phosphatase, gamma glutamyltranspeptidase and bilirubin.

    Tests of hepatitis A, B and C were negative. Immunoglobulin levels were normal and tests for autoantibodies, including antinuclear antibody, smooth muscle antibody and liver-kidney microsomal antibody, were negative.

    A liver biopsy showed changes suggestive of chronic aggressive hepatitis with marked lymphocytic inflammation, interface hepatitis, and both focal and bridging necrosis. Because the histological and clinical features supported the diagnosis of severe autoimmune hepatitis, prednisone was initiated, with prompt improvements in serum aminotransferase levels.

    Prednisone doses were gradually reduced and ultimately withdrawn. Serum enzymes were normal within 2 months of starting prednisone and the dosage was gradually reduced and then withdrawn 3 months after initiation.

    An example of an acute hepatitis-like syndrome arising after pulse methylprednisolone therapy. These episodes arise typically 2 to 4 weeks after a third or fourth cycle of pulse therapy, and range in severity from an asymptomatic and transient rise in serum aminotransferase levels to an acute hepatitis and even fulminant hepatic failure. In this instance, the marked and persistent rise in serum enzymes coupled with liver histology suggesting chronic hepatitis led to a diagnosis of new-onset autoimmune hepatitis, despite the absence of serum autoantibodies or hypergammaglobulinemia.

    Autoimmune hepatitis may initially present in this fashion, without the typical pattern of serum autoantibodies during the early, anicteric phase. The diagnosis was further supported by the prompt improvements in serum enzymes with prednisone therapy. The acute hepatitis-like syndrome that can occur after pulses of methylprednisolone is best explained as a triggering of an underlying chronic autoimmune hepatitis caused by the sudden and profound immunosuppression followed by rapid withdrawal.

    This syndrome can be severe, and fatal instances have been reported. Whether reinitiation of corticosteroid therapy with gradual tapering and withdrawal is effective in ameliorating the course of illness is unclear, but anecdotal reports such as this one suggest that they are beneficial and should be initiated promptly on appearance of this syndrome.

    Long term follow up of such cases is also necessary to document that the autoimmune hepatitis does not relapse once corticosteroids are withdrawn again. Expert review of hepatotoxicity of corticosteroids, focusing upon fatty liver and alcoholic hyaline-like changes with high doses or long term low doses. Chitturi S, Farrell GC. Adverse effects of hormones and hormone antagonists on the liver. Review of liver injury from corticosteroids mentions hepatic steatosis and acute liver injury following high dose methylprednisolone.

    ACTH, adrenal steroids, and pharmacology of the adrenal cortex. Textbook of pharmacology and therapeutics. Hepatomegaly with fatty infiltration secondary to cortisone therapy:

    Corticosteroids

    intermediate acting steroid

    Corticosteroids and Corticosteroid Replacement Therapy | Patient

    intermediate acting steroid

    Corticosteroid - Wikipedia

    intermediate acting steroid